Conversation with Tyler Norris

Welcome and Introduction of Tyler Norris

Lia Mix: Hello everyone, and thank you all for being here. This is Delphi’s second insight session, and we are thrilled to have Dr. Tyler Norris with us for a conversation that builds on our introduction to Delphi’s work at the intersection of psychedelics and the incumbent systems of healthcare, finance, and government.

We are also joined today by Floris Wolswijk, the founder of Blossom and a senior research and policy partner here at Delphi. For those of you who may not be aware, the Blossom platform serves as the leading data platform for the psychedelic industry, translating complex research into actionable insights for the clinical implementation of psychedelic-assisted therapy. Floris is based in the Netherlands and has also co-founded FLO Coaching with his wife, Lotte, providing psychedelic-assisted coaching with a focus on preparation and integration. As a core team member of Delphi, Floris advises organizations within the psychedelic ecosystem and the incumbent systems we’ve mentioned—government, healthcare, and finance—focusing on the medical introduction of these medicines into the US and European healthcare systems. I’m so grateful to have Floris as a partner for these many years at Delphi.

Floris and I are so thrilled to have an opportunity to converse with Tyler Norris, who is the co-founder and director of the CEO Alliance for Mental Health. Tyler brings over four decades of experience as a social entrepreneur and trusted advisor to philanthropies, partnerships, and government agencies focused on improving wellbeing and systems change for human flourishing. As the founding CEO of the Wellbeing Trust and a current senior advisor to organizations such as MAPS and the Psychedelic Science Funders Collaborative, Tyler offers a unique perspective on building sustainable mental health initiatives. Tyler operates in a key bridge role for psychedelics, and he is the ideal person to help us explore how psychedelic therapies fit within the broader mental health transformation and discuss the strategic approaches we can use for creating lasting system change. You can learn more about Tyler and his work at tylernorris.com, and we definitely encourage everyone to do so. With that introduction, I will turn this over to you, Tyler. Thank you.

Tyler Norris: Thank you, Lia, for that beautiful opening. It’s so good to be here with you and Floris today and with those who have gathered for this call. I’ve been looking forward to this. Floris, we only met recently, but I’ve been inspired by your work and am really looking forward to engaging with you. Lia, over the last six or seven years, we’ve had a number of chances to work together in various areas, particularly in what you described as the incumbent mainstream mental health and wellbeing field. I’m just so thrilled about what Delphi is doing and curious to learn more.

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Delphi’s Collaborative Mindset and Bridge-Building Role

Tyler: To provide a bit of context, in my current role with the CEO Alliance for Mental Health—which gathers the CEOs of the nation’s leading mental health organizations like the American Psychiatric Association, American Psychological Association, social workers, NAMI, and Mental Health America, along with some of the big funders—we’ve been focused on ensuring people have access to mental health care in the first place, that it’s paid for with parity, and that people have access to care. Increasingly, as these novel therapies have emerged back onto the scene with incredibly promising research, there is a real readiness and ripeness in the incumbent field to engage. In some cases, this means letting current research and education evolve their positions and their readiness for rescheduling and for taking advantage of what’s happening in the states. It’s incredible to see Delphi at the front edge of what that looks like.

Perhaps that’s a good place to jump into the dialogue. This could be for both of you, but maybe Lia, you can begin. You’ve been at Delphi, working somewhat quietly for a couple of years. I know some folks have been watching what you’re doing—listening, learning, and building in the field, focusing on areas others have not. You’ve finally revealed some of the bigger projects you’re working on. What would you tell us about the things you’re most proud of in your work so far under the Delphi banner?

Lia: Thank you so much for that question, Tyler. I would say that the things I am most proud of, number one, are our collaborative mindset. In an emerging industry, a lot of tensions can arise regarding how people think things should be done. At Delphi, we are focused on safe, broad, and affordable access to these medicines for everyone who can benefit from them. That requires keeping an open aperture. When we look at medicalization, which is our domain expertise, we also see state-level therapeutic use models, religious use models, and so forth. We absolutely like to keep the models we create in our mind non-exclusive to other forms of access. That takes more agility and the ability to hold complexity.

That brings me to the second thing I’m most proud of, which is this team. Not everyone knows what it is to build and bootstrap a startup company in an emerging industry with an incredible amount of uncertainty and all kinds of complexities. What I have seen from this team is the greatest amount of creativity, passion, and willingness to sacrifice because of this larger vision we are all holding for how these medicines may be able to end and heal suffering and shape humanity in a positive way. I couldn’t feel more supported as a leader and more appreciative of the talent and the hearts that we have here at Delphi.

Floris: Thank you, Lia. I think you’re really sharing the vision and how we’re looking at this. More concretely, I think we’re really glad to be that bridge between the psychedelic ecosystem and the broader landscape of finance, healthcare, and government. But also, from my own perspective of mapping out the research, we aim to be the bridge between research and implementation. We’ll probably talk about this more, but in the HOPE project, we are really looking at the costs—and of course, the benefits—of psychedelic-assisted therapies. We want to implement that and look ahead at how much it will cost and how beneficial it will be. We have some great academic studies on this now, but we are testing it on real-life scenarios within parts of the healthcare system with the HOPE project in the US. We’re also looking at doing this for Europe, where we have almost nothing on health economics.

Focusing on Mainstream Decision-Makers

Tyler: Fabulous. I’m really impressed with this movement from the promise of what’s possible to putting it into practice, Floris, in the areas you were just describing, so that there is a basis for safe and meaningful adoption. And back to your point, Lia, that we’re not excluding various pathways, but we’re particularly interested in the clinical mental health pathway that could lead to reimbursement and care being paid for those who can benefit.

In the first Delphi session, you discussed the intentional focus on decision-makers in the systems of healthcare, finance, and government. What drives your decision to focus on these stakeholders who sit outside of psychedelics but are in the mainstream field? I’m recalling what you referred to in Buckminster Fuller’s work about how you have to change the thinking in a field. Tell us a little bit about why you have this intentional focus when so many others are trying to move forward with safe adoption in the psychedelic swim lane. You’re out building bridges.

Lia: That’s really the heart of it for us right now. We recognize that we are at a juncture where there are so many decision-makers—we are talking thousands and thousands of people—who will need to make good decisions about psychedelics, but we cannot expect them to actually care about psychedelics. We cannot assume that they will have had a good psychedelic experience. They may even be working with misinformation. One of the things we realize is that anyone over 35 has been really indoctrinated with misinformation.

So what we see is that as you try to get these systems, which we absolutely need, to adopt psychedelics, at some point you will run into a decision-maker who is operating from fear-based information and mentality, consciously or unconsciously. I have seen this working in the commercial health insurance industry, where my job was to get insurance carriers, insurance plans, and self-funded groups to make big decisions about, for example, adopting new coverage. What happens is that you will get to one key decision-maker and everything will grind to a halt. That key decision-maker will just dig their heels in and say, “No, this is not going to happen.” Now we have a loss of efficiency and things that have moved really far down the road only to fail at the last stages.

We need to reduce that friction very proactively and reset those folks’ understanding or motivation to make good decisions about psychedelics by appealing to their own motivations. The way I like to frame it is, in the commercial health insurance industry, I used to work to bring the legal, moral, and financial trifecta of hard facts to a decision-maker in a very tidy package for them to digest, so that they are prepared when this decision hits their desk to make the right choice for their organization. That’s how we would love to help prime these industries. We feel very strongly, by the way, that non-advocacy education is the way to go. It needs to be science-based, fact-based, and respectful of decision-makers’ autonomy to make good decisions for their organizations and what is under their scope.

We also feel that if these facts and the science are presented in the way they need to be, and contextualized appropriately, that by and large, we’re going to see good decisions made and adoption happen more quickly. I want to say one last thing: it is so easy for us who work in psychedelics to get a bubble mentality. We really think that the rest of the world is further along than it actually is. We drink our own Kool-Aid, so to speak, and see the media and say, “Oh, isn’t everyone on board now?” No, we’re very far away from that. I think we unfortunately saw that come to a head with the recent FDA advisory committee meeting for Lykos’ MDMA therapy, and we should expect more of that if we don’t get out ahead of it.

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Opportunities in State-Level Initiatives

Tyler: Thank you. I’m going to talk a little bit about the state of the field, and then we’re going to come back to what we might do in some of these states that are presenting particular opportunities to build out elements of the clinical mental health pathway.

Just thinking a bit about the field—many of us are just two weeks out from the Psychedelic Science conference, which gathered almost 8,000 people from around the world. We saw leaders from the American Psychiatric Association and National Association of Social Workers there, ranking members of Congress, the Veterans Administration, and even representatives of the administration. They’re being educated in a good way by groups like MAPS, the Psychedelic Science Funders Collaborative, and other interesting groups. I’m thrilled with the kinds of partners we’re seeing. This field is growing significantly to meet the requirements of building these bridges.

The laboratories of New Mexico and Texas, in particular—for example, Texas’s new $50 million investment in ibogaine clinical trials—are places where the professional guilds and others, who have been a bit reticent to go all the way until they feel the research is in place, can experiment. These are living laboratories for experiments around the workforce of the future, getting the data for quality and reimbursement, and ensuring practice guidelines and protocols are being built. How do you see your role and the opportunities in these states where the voters have spoken?

Lia: I love this question, Tyler. It is something that we have been tracking for many years in a hopeful way, and it’s starting to play out in ways that we think are good for access. Let me frame this a little bit. Historically, we think about the spectrum of access as having three wedges: medicalization, state-level therapeutic use, and religious use. Those are all what could be considered regulated use. It’s very easy for us to get into siloed thinking, where we just focus on medicalization or see competition where if something is happening in one area, it’s a threat to what’s happening in another.

What we see, however, is that the will of the people, the states, and the governments in these states is to look at where these things can weave and intersect. We feel this is the best possible opportunity for access. You can have lower-cost care for people who don’t have an extreme medical need and, at the same time, higher levels of care in the medical system for people with more serious cases. Now we start to get this full spectrum of access that can also benefit from the reimbursement systems of Medicare, Medicaid, and even possibly the commercial markets.

It is also amazing to see the states get in on the ground floor of funding research, as they have with ibogaine in Texas. Often, we see that funding come from the federal government, from NIH and so forth. This is a new paradigm. This is a shift that it’s a little bit bigger and better than I think we could have hoped for, and we need to make sure that we’re really considering all of the stakeholders and bringing everyone to the table as we start to shape exactly the things that you talked about: What are the standards of care? What are the standards of training? Who is doing the licensure? What patients or participants are able to access care through what mechanisms? And how is that paid for? The opportunity here is great, the complexity is great, and I think that’s really where we thrive.

Reimbursement Pathways: Europe vs. the US

Tyler: Fabulous. I just love where we are with this and what’s possible, including clinician self-experience and other forms of supervisory training that state models like these can inform. I’m thrilled about that. Since reimbursement is on our minds in the United States today, maybe we can turn to Floris in Europe for a minute to talk about some of your work on reimbursement pathways for psychedelics there. Obviously, they are very different systems, but the logic of state Medicaid and some big integrated health plans runs like the logic of some European countries, so there’s a lot to learn. Floris, maybe you could share some highlights from your recent report and what that might mean for Delphi’s future work in Europe.

Floris: Yes. I think in the US, different states are experimenting with different things, and you can also see Europe as some states together under the European Union, plus the UK and Switzerland, where some things are already happening. We can see different models being tried. For me, it came out of left field that psilocybin will soon be available for medical use in the Czech Republic. It is amazing to see that moving forward. Then there’s the natural experiment of unregulated use here in the Netherlands. There’s a lot to learn from what is already going on, versus only starting to learn when something gets Phase 3 approval.

But what’s happening here? On one hand, a lot is happening. On the other hand, we’re still quite far behind in comparison to the US. Around health economics, we have one published study that, at a high level, looks at the UK and what happens if you implement psilocybin. It can be cost-effective, but we don’t really know how that will work. Tyler, you made the comparison with a Kaiser Permanente-like program, but even within Europe, there are so many different systems. The NHS in the UK is totally different from the semi-commercial insurance in the Netherlands. There’s still a lot that needs to be figured out for implementation.

One big challenge and difference between the US and Europe, as I see it, is that in the US, if you have the money, a lot of things are possible. The healthcare system, if you pay enough, will do it. Here in Europe, it’s really more supply-constrained. A big challenge we have to face here is the number of therapists available. I think you also see this in the US, but a lot of therapists are burned out, and many are leaving the insured sector to start private clinics. We have to see how we can balance the request for a lot of therapist hours, which we see in protocols like Lykos’s, with making these therapies widely available. But if we have amazing efficacy on the other side, I think it can also happen in the European system.

Tyler: Really helpful. It’s incredibly promising—in some places ahead of the reimbursement system and some behind. And maybe, Lia, before we pivot, just to speak to reimbursement here in the US. We’re all aware today that Congress is looking at Medicaid cuts, and I think there’s concern that some of what is being considered might reduce opportunities for some reimbursement and undercut medical care access for the most vulnerable. But there’s still quite a system to build on. Maybe you want to speak a little bit about what you’re seeing in reimbursement here in the US and what is possible with Medicare, commercial payers, and other methods in addition to Medicaid.

Lia: Yes, thank you, Tyler. It’s interesting; as if psychedelics weren’t complex enough, there’s a lot of movement in the healthcare delivery and payer systems. I want to take one quick step back to say we are very hyper-focused on efficiency. It’s been interesting as we have done the mapping in Europe and looked at the US to see how much overlap there is in the content that needs to be created. Standards of care, standards of training, how reimbursement is structured, coding, what services are included—those are actually very similar between Europe and the US. It’s just the pathways that need to be taken and the decision-makers involved that differ. We think that will hopefully lead to some really interesting international opportunities for collaboration that could lend efficiency.

Regarding the changing landscape of Medicaid, I want to take a very realistic look at this. The first is that Medicare and Medicaid tend to be the slowest in terms of any kind of coverage adoption. You’re probably going to see the commercial markets move more quickly. Also, when we are talking about implementing something of this nature and novelty into the healthcare system, we’re talking about a much longer timeline than people realize—one that vastly outstrips political cycles. As a field, we need to think about what resources and what landscape we have to work with right now and just keep our eye on the prize of access. Where are the opportunities for access right now? We must understand that those opportunities could change in the future, one way or another. It’s both a short-term and a long-term view, but it’s important for people to see that the changes happening right at this moment may not even align with the normal timeline of when we would expect Medicare and Medicaid to adopt this coverage.

Delphi’s Vision for the Future

Tyler: Super helpful. This is a very interesting time. Uncertainty is the watchword of this moment. But if you had a crystal ball, where would you see Delphi in the next 3, 6, or 12 months? What’s on your horizon?

Lia: In three months, we would really like to see all of the projects we have presented—in terms of developing the economic analysis and the non-advocacy education for decision-makers—funded. Then, over six to 12 months, we want to see that analysis being done, papers starting to be published, and the actual deployment of that information into the public domain with a strategy to ensure the right decision-makers are using it in the most advantageous ways. This would lay the groundwork for psychedelics to come through, in pace with what we see happening at the FDA.

Many of us have heard about Robert Kennedy Jr.’s comments to Congress about a 12-month window for psychedelic therapies to be covered. Okay, that’s no time at all. That means “get ready now.” We need to be in a full sprint. We’re really poised and ready to begin executing once all the funding is received and all the stakeholders can be gathered. We’d like to see a qualitative difference in the system’s readiness for implementation when we reach those coverage decisions.

Floris: I totally agree with what Lia is saying. To focus here on Europe, it’s not even necessarily about having all of that executed in the next few months, but really about having that roadmap mapped out in way more detail. We have a roadmap, and we have the pillars we need to be working on. For instance, for health economics, we know exactly what we want to do. Starting next year, we want to get that work going and see how we can both catch up to the US and also make that implementation roadmap happen specifically for Europe.

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Q&A with Tyler Norris, Lia Mix, and Floris Wolswijk

Q1: Should new CPT codes be developed for psychedelic therapies?

Floris: Do you think new CPT codes for psychedelic preparation, dosing, and integration should be developed, and should they be based on the type of psychedelic used for care?

Lia Mix: That question can be answered over time, and it is a bit of a chicken-and-egg situation. You want to see the system willingly adopt this treatment. Sometimes that means using what are called orphan codes or existing service codes to expedite those services being available and reimbursed. What you’re asking, Melodye—creating novel CPT codes, especially ones that are medicine-specific—becomes a burden within the system. It’s a heavy lift. The system actually needs to see the reasons why it should go through that exercise, from creating the codes to then retooling all the claim systems and provider contracting. It’s a massive effort.

I think for psychedelic healthcare in general, we’ve already seen a new temporary code set developed by Lykos, which is always the first step. We’ve also seen work by Brain Futures. So, it’s happening. The degree to which it needs to be at the level of granularity you’re suggesting is to be determined. We really want to find that sweet spot between what works for the system and what works for the providers and the well-being of those offering the care.

Tyler: That was such a comprehensive answer, so I’m going to build on it from a different direction with a big “ditto” to much of what you said. We don’t even have CPT codes for a pediatrician to talk to a mom and their kid about their mental health issues. That’s the actual state of reimbursement for clinicians around mental health care. This is why the work by many of us with the mainstream field is so important. They are working to make sure insurance pays for mental health care in general and that clinicians are paid for mental health services altogether, not only for these novel therapies. As we join forces with the broader field, we should remember that they are looking at how we make these codes available for reimbursement for everyone. In the psychedelic field, we need to understand where our partners are, because the more successful they are in getting billing codes, the more successful we will be.

Q2: Will the APA and NASW help develop standards of care?

Floris: Given the exciting attendance of both the APA and NASW at Psychedelic Science 2023, have they also shown interest in leaning in to help develop standards of care and standards for training and accreditation?

Tyler: First of all, Jeremy, I just want to start with the excitement in the field about what you and your partners are doing. It’s really mattering to build the infrastructure that would allow the professional guilds to come along. To the core of your question, Dr. Marquita Williams on stage in Denver was very clear: “We need to be ready for rescheduling.” That’s pointing to the very things that Lia was just talking about—making sure those practice guidelines, protocols, and standards of excellence are in place. They see that they have a very key role in that.

What’s happening now, which is probably the curiosity of a lot of people here, is that the senior staff inside those guilds who have been working on safe, equitable access to psychedelic-assisted therapy are now getting more light shined on their work. They are connecting with each other, not only inside the guilds but across the guilds, to prepare for this. So I would say that while there was big excitement to have those key professional association leaders there, it wasn’t just symbolic. It’s bringing the senior members of their teams into action to get ready, building on the work of psychologists, psychiatrists, social workers, psych nurses, chaplains, and others across the field. I think we’re in an extraordinary position for those standards of training and accreditation to be built out.

Q3: How can the medical field respect indigenous rights and knowledge?

Floris: A question from Julia: As industries like energy and agriculture face increasing demands for environmental and social accountability, particularly regarding impacts on indigenous communities, how prepared is the medical field to advance research while properly acknowledging and respecting the rights of indigenous people whose traditional plant medicine knowledge forms the foundation of much current pharmaceutical research?

Tyler: I can speak to what was said by both Dr. Marquita Williams and Dr. Anthony Estreet, CEO of the National Association of Social Workers. Dr. Williams’ opening comments had to do with respecting the medicine and wisdom of our indigenous communities and showing deference to hundreds, if not thousands, of years of working with these plant medicines. This includes their interaction not just with the individual, but also in community and peer settings capable of spreading healing and making individual, family, societal, and cultural changes. Julia, I love your question because it goes to what I saw these leaders really leaning into. When Dr. Estreet gave his talk, he was followed by the Indigenous Medicine Conservation Fund putting out their declaration, and he acknowledged as he closed that while social workers are used to taking a whole-person, whole-community, spirit-mind-body view, if we really wanted to do it right, we need to be looking to the wisdom of indigenous leaders and communities.

So, how prepared are we? To your good question, Julia, I think it had better be a big pebble in our shoe to make sure we bring that along. But we have signals of deep respect and understanding of what our indigenous medicine communities have to offer here. We’re wise to be paying very close attention, learning in partnership, and also making sure that we’re doing no harm to the religious use pathway.

Lia: Tyler, that’s awesome insight. I’ll take it from a different angle. When you say “the medical system,” there are a lot of different parts to that. The signaling that Tyler is speaking to is coming from the hearts and the minds of the people who are leading as clinicians. That is where I think a lot of the energy for upholding this ethos is going to reside in the beginning. In my experience, the system itself is always looking for things to be streamlined and less complicated. Mystery is not streamlined, and it is certainly complicated. Having indigenous wisdom or sacredness—I think that there can be a resistance inside of the system that is just in a rush to create efficiencies of scale and have certain economic returns.

That’s the built-in bias. What Tyler is sharing is so very important because if we’re going to shift the zeitgeist around that, we’re actually going to need to bake that into how we set up the rules that the system adopts. The will to do that will need to be coalesced within organizations and with individuals to reach a critical mass and make sure there is a way to translate to the system what is actually desired and what is actually in right relationship. This has been very close to my heart for some time, doing this weaving in a wise way. How do you get the system to voluntarily adopt what is foundationally a shift in cosmology? It’s fascinating, it’s critically important, and thank you so much for the question.

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Lia Mix: Thank you both so much. Let me start right there. Thank you, Floris, and thank you, Tyler. This was just as we had hoped and expected, and even better. We really appreciate you infusing your good questions and your wisdom into this conversation. So thank you for your time, your intelligence, and your goodness in this conversation and in the field in general. And thanks to the audience for being here, for all of your good questions, and for your interest in our work. We’re always happy to field questions offline.

The next Insight Session, our third, will be next month. It’s always the first Wednesday of the month, so it will be August 6th. We look forward to seeing you here then. In the meantime, have a wonderful Independence Day and a happy summer. Thanks, everyone.